Individual
ERICA D GORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1533 DUXBERRY AVE, COLUMBUS, OH 43211-1619
(614) 357-1937
Mailing address
1533 DUXBERRY AVE, COLUMBUS, OH 43211-1619
(614) 357-1937
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Enumeration date
02/08/2023
Last updated
02/08/2023
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